Visible signs of acute/severe anxiety*


Session 12 says signs of anxiety are not visible to others - I beg to differ as I suffer from very visible anxiety symptoms- am I missing the point here cause I read and reread this handout and am very puzzled. I suffer from the worst type of ANT’s and they have ruled my life for over 3 decades. My anxiety is severely acute! Is there any hope for my recovery+ I go blank automatically in the company of others and have overwhelming need to leave situation, any social situation. Would appreciate reply from Dr. Richards or anyone at all, Siobhan I am on session 12 at present time***thank you! Am I suffering from SAD?


well the gist of the handout is that often these signs are not as visible or telling as you think and also that others just dont care as much as you think.

many people dont mind an anxious person as long as youre friendly. some people may feel a bit uncomfortable when there are very visible signs and will themselves get a bit anxious about it. few people actually just dont like it, but this does not kill you. people are entitled to have their opinions, this does not have to bother you at all. your job in the therapy is to not make a big deal out of these symptoms, because if others see that you are ok with it, they are more likely to be ok with it themselves.

however people react (if they really are reacting to visible signs, remember that they might not) - they are always reacting to what they see. they never react to you as a person. remember that you are not your sa. your sa is not an an integral part of your core identity, whatever you may believe about it at the present time.

have faith in the therapy and your ability to make progress. if you keep going there will be a time where none of this matters anymore.


Hi Siobhan,

Yes, I am very sympathetic to your post. I also have VERY obvious visible symptoms (extreme blushing/sweating). I think this is a very good series, but my one peeve is the discussion (or lack thereof) regarding visible symptoms. It’s mentioned in passing a few times, and session 12 is the only place where it’s discussed in any depth, and even here it’s minimal. I believe they could have devoted multiple sessions to dealing this very topic.

…OK, rant over… I think the gist of session 12 “Automatic cycle” is that our visible symptoms may be visible to others, but they’re not as obvious as we believe. I’m guessing that for most SA sufferers this is true, but there is a subset of us who have VERY strong visible symptoms like myself. For me, it’s not unusual to be called out on my symptoms. When this happens, it’s the worst possible thing and it’s totally devastating.

…So no, you’re not alone in your thinking regarding visible symptoms…here’s a very good video on this topic:


The reason it wasn’t gone over in depth is because we blow things out of proportion in our minds. I blush and sweat and sure sometimes people may notice or even remark on it, but it’s not that big of a deal and a lot less people are noticing it than we think. And when people do notice they aren’t thinking over and over “Look she’s blushing!”. Most likely they would just be like “oh he’s blushing” and then never think about it again.

We tend to want to take that 1 out of 100 person who remarked on us blushing and first apply it universally (in our minds we start to think of it like EVERYONE remarked) and then we also interpret it negatively. This has been the lesson to me about physical symptoms over the past 12 sessions.

So when I have physical symptoms and the ANTs that come along with them I simply apply the ANT squashing techniques that we’ve learned so far. I’m blushing and people might notice. WHO CARES? I’m not going to let these ANTs rule my life. That’s what this really is, an ANT. ANTs try to get into our minds and seem legitimate no matter what they have to do. You having physical symptoms is just another way for the ANTs to get in, stay in and ruin your life.


Good advice provided by this video. If you notice, much of this is the same advice Dr. Richards provides with coping and attitude statements.

I also wanted to share an experience that supports the idea that others are not aware (in many cases) that you’re feeling anxious. A therapist I was seeing for SA requested that I videotape myself in stressful/anxiety provoking situations (giving presentations). I was able to do this because I had to give presentations online from my home. So I set up my phone and took videos in these situations. While I was presenting there were moments when I felt highly anxious and I was sure that others could see that I was stumbling and not making sense. I was also sure that I was showing physical symptoms of anxiety. To my surprise as I watched the video back, I could hardly tell at what point I was having the symptoms (this was an amazing revelation the first time I watched myself!). I showed the video to my therapist and she could not point out where I was feeling the anxiety. I’ve since made many videos like this and I watch them to remind myself that even I can’t tell sometimes where I was feeling anxiety, much less others. But as stated in this video and has Dr Richard states, it’s OK even if it was noticed. There’s nothing I need to fear. If someone notices, so what? What’s the worst that can happen? Are we making a mountain out of a mole hill? If we play these scenarios out, I think that we will find that we are. And this is EXACTLY what is feeding our SA.


I started using this therapy series in 2007 precisely for physical symptoms - blushing. Or, at least I thought that was the biggest problem in my life. If I didn’t have just this disastrous problem, I thought, then I’d be totally fine! If I could count on myself never blushing or sweating, then I wouldn’t have to be nervous. I could stop avoiding. I could get a job. I could live a life. I could be “normal”. This was definitely my primary driver for starting the therpy.

I, too, looked for more specific and lengthy discussion of physical symptoms on the old Dr. Richards’ website. I looked for it more in the therapy. It was and is addressed, as you mentioned. We have articles on it. But from the perspective of someone like me, back at that time, it didn’t seem like it was given enough importance. “But, whatever!” I thought. Everything I read on the site was familiar to me. All the dwelling and post-event rehash thinking. It all made sense to me, so I went with it.

I came to the International Group and still expected physical symptoms to be at least some sort of topic we’d focus on at a particlar time. We didn’t then either. We didn’t separate it into a day’s focus or a single lengthy discussion. We did discuss it any time it was brought up by a group member, such as if the person wanted to do a behavioral exercise for the reason of being on the spot, worrying about that response, and practicing slowing and calming down.

Most every group member has some sort of physical symptoms they worry about.

I wouldn’t exactly say that the topic is not front and center, does not have its own session, because Dr. Richards is directly avoiding that topic for a reason such as if we focus on it it makes people, in turn, focus on it more. I wouldn’t say that now, but I’ll ask him why and report back. I’d guess that it’s not made a “star” because the solutions are the same for all of this anxiety, the solutions presented in the therapy. The solutions are for anxiety, and anxiety causes all these other symptoms.

For me, those same strategies were the answer for my irrational fears about physical symptoms. My symptoms began when I was 10. I didn’t begin therapy until I was around 30. So that’s plenty of time to build them up, obsess over them, make them giants.

If you went to another therapy for help in overcoming a physical symptom, well likely they’ll give you some good advice, too. Rational advice is not hard to come by. It’s not rocket science to say we all could be helped by slowing down. Then what is the program going to do for your symptom? Also, is that going to be enough? Is the symptom the root problem?

Blushing started innocently enough in my life, but from the very first time it was followed by intense shame, embarrassment, failure, and depression - even at that age. Ask yourself why should such extreme negativity jump up after something like that? Is that normal? I really don’t know. Humiliation may trigger that in most of us. But it’s not setting me up for a healthy long-term outcome. And yes, there was other stuff going on in my life then. So, I would say that blushing wasn’t THE problem. I’d say that now for sure. I wouldn’t have had the vision to see that then.

My opinion, and it’s highly influenced by my experience and by doing therapy this way, is that you’d still need to go through a structured step by step program like this, to deal with the root issue, the anxiety of it all, the over-thinking, the brain patterns developed, the self-rejection, self-hatred.

As I’m reviewing the series to update it for our next hosting platform, I do think we hope to add more discussions on the topics that people want to see discussed. I would hope those discussions help alleviate the worries or confusion enough to get on with the therapy because the discussion will turn out to be something of the nature of these posts. Do the therapy after all.

A woman communicated with me a few months ago, she was asking for resources for anxiety help in her area. She also mentioned that the upcoming weekend she was going to a seminar for helping with the fear of public speaking. She described social anxiety in a way that made me understand that she understood and had social anxiety. You know how it is when you have had or have social anxiety, you can feel quickly if someone else gets it or not. She got it. So she was dealing with social anxiety disorder, and she had described situations previous where she flooded herself. But, to her credit, she was driven to try.

She was going to this seminar/workshop, and I don’t know how it went. I hope it went well for her. I did wonder if it would really be helpful or not. For something to work long-term, she would have to cognitively be in a place where she is dealing rationally with it, applying and using strategies. So the situation certainly presents an opportunity to get better at public speaking, or to practice slowing down in that situation - yes. But, was that going to be helpful long-term for underlying social anxiety? It wouldn’t have helped me, so I speak for myself. And I did think, at different times in school, that if I could only give that presentation, or perhaps if I could bust through that presentation and/or speech class, then surely I’d have broken this confusing problem up. That didn’t work. It never worked because I wasn’t doing a more complete program of slowly and gradually dealing with all this stuff that is the support system of all this wacky anxiety.

I’m all for public speaking classes. Great opportunity for us to apply our therapy, when we’re able to handle the situation rationally. Also, great opportunity to better a skill. I’m all for advice for not worrying or tips to deal with certain symptoms. It’s not going to be bad advice. Just make sure you don’t sacrifice a broader, effective solution for a piecemeal approach.


Me: “What would your response be to the following: the therapy series for social anxiety does not spend enough time discussing the issue of physical symptoms. Sure, it’s mentioned in different places, but not in the detail perhaps deserved, especially for those dealing more with physical symptoms. Why doesn’t it have a dedicated session?”

Dr. Richards: "Well, there aren’t any specific exercises for physical symptoms, not ones that are helpful anyway. Blushing is the best example. People who suffer from blushing think it’s their problem, the problem. Many times they don’t think it’s social anxiety. There’s no therapy that can help someone get over blushing singularly, by itself, and ones that claim to are a waste of time and money. But if you put the therapy or program into context, usually social anxiety (and in our groups it’s social anxiety), learning to think rationally and logically helps alleviate and deal with it gradually. I said gradually. Gradually it can go away. Gradually because usually the person has spent decades dealing with the symptom, and blushing often has a genetic component. So gradually, with a lot of rational thinking, the therapy, the person learns not to respond to it.

The other symptoms, something like sweating… again you’d help people learn how to become as calm as possible, slow down, while applying rational thoughts, so this again is the basic social anxiety therapy we do here anyway. There is nothing specific to do for that, either, outside of drastic measures taken by some medical doctors which is unhelpful and misguided."

The mistakes in the answer above would be mine, if there are any unintented changes in his meaning. I was scribbling, just trying to get the main points of his verbal answer to the question posed.


When I read Handout 12 I too remember freaking out a bit, because I felt my physical symptoms are really noticeable. But as I read in subsequent handouts I realized it’s not so much about the symptoms as our relationship to them.

A few months ago I saw a lady audition for a theater role and during the audition she was visibly trembling. Had I been in her place I’d have buried myself under a rock of shame forever (and I have done that), but she didn’t seem to care and neither did anyone else.

As one of the handouts says those with SA tend to give so much importance to symptoms and it’s this pressure that keeps them in place. So that’s what I am trying to focus on - relieve myself of the pressure, judgement etc.